Question

Ms. Johnson, a whiplash victim, has been suffering spinal shock but is looking forward to complete recovery. One night on evening rounds, her nurse discovered her in a fetal position, her body drenched with sweat. She was incontinent of feces and urine and her blood pressure was dangerously high (over 200 mm Hg). After a while she was stabilized. How could these events happen and what is this response called?

Answer 1

• If Ms. Johnson had been suffering spinal shock, then it is clear that the injuries to her spine are a lot more than just whiplash injury. Evidence for this is also provided by the episode of dysautonomia which she suffered.
• Spinal shock is a condition where essentially the lower motor neurons (LMN) are not responsive to upper-motor neuron (UMN) input. In Ms. Johnson's condition, it would seem that (as a result of whiplash), her body from the neck down is removed from UMN regulation. Thus, the fetal position may be attained as a result of HYPER-reflexia (characteristic of UMN lesions) of both upper and lower extremities, due to the LMN circuits still being intact and functioning in an unregulated fashion.
• Her incontinence is termed dysautotonia, and results from removal of input from higher regulatory centers of the autonomic system, also consistent with spinal shock -- her increased blood pressure is consequent to the same dysfunction. In her case, these 2 symptoms are caused by removal of parasympathetic tone (which normally permits micturition/defecation, and lowers blood pressure).